Fluticasone-Salmeterol Combination in Moderate-to-Severe Asthma

• Routine use of short-acting beta blockers like salbutamol and long-acting beta blockers like salmeterol may cause deaths due to asthma-related events.
• Severe asthma-related events are similar in those taking salmeterol with fluticasone or fluticasone alone.
• Combination of salmeterol with fluticasone is associated with lower risk of severe asthma exacerbation as compared to fluticasone alone.

The combination of the anti-asthma medications salmeterol and fluticasone does not cause more serious asthma-related events than fluticasone alone when used in the treatment of moderate-to-severe asthma, highlighted a recent large study published in the New England Journal of Medicine. Beta agonists like salbutamol or albuterol have been used for several decades now for the management of asthma patients. They relax the bronchi and provide immediate relief to an asthmatic struggling for breath. The inhalers provided local relief of symptoms without side effects to other parts of the body.

A short duration of action of the older beta agonists necessitated frequent doses. To overcome this, long-acting beta blockers like salmeterol and formoterol were brought into the market. Addition of corticosteroids ensured additional relief from inflammation.

The Serevent Nationwide Surveillance (SNS) trial and the Salmeterol Multicenter Asthma Research Trial (SMART) found that regular use of salmeterol was associated with higher risk of asthma-related deaths as compared to salbutamol or placebo, respectively. A further study suggested that these deaths could be reduced when salmeterol was administered with a corticosteroid, fluticasone propionate.

The study published in the New England Journal of Medicine compared the use of a fixed dose combination of fluticasone and salmeterol with fluticasone alone in patients with moderate-to-severe asthma of at least a year’s duration and requiring daily treatment. The patients had an exacerbation of asthma in the previous year. The study was conducted in 33 countries and treatment of either fluticasone alone or in combination with salmeterol was administered for a duration of 26 weeks.

The researchers noted the following:

• Serious asthma-related events were similar in the two groups (36 events in the fluticasone–salmeterol group and 38 in the fluticasone-only group).
• The risk of a severe asthma exacerbation was lower with the fluticasone–salmeterol group as compared to the fluticasone group.
• No asthma-related deaths occurred in either group.
• No age or racial group was found to require more frequent hospitalization due to asthma.
• The percentages of withdrawal from treatments due to side effects were similar in both the groups (3%).

Thus, the combination of fluticasone and salmeterol may be preferable to either drug used alone in the treatment of moderate-to-severe asthma.

Reference:

1. Stempel DA et al for the AUSTRI investigators. Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone. N Engl J Med. DOI: 10.1056/NEJMoa1511049

Source-Medindia